LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

Orientation and On-boarding

LTC+ is a collaboration between Women’s Virtual at Women’s College Hospital, GEMINI at Unity Health Toronto, the Ontario General Medicine Quality Improvement Network, the Centre for Quality Improvement and Patient Safety and the Department of Medicine at the University of Toronto

Agenda

• Welcome and Introductions • Current Situation • Goal of LTC+ • Model of Care • Collaboration Principles • How to Get Started • Discussion

LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

Meet the Team – LTC Engagement

Dr. Andrea Moser Dr. Pauline Pariser Long-Term Care Lead Clinical Lead Baycrest Centre Women’s College Hospital [email protected] [email protected]

Laura Pus Dr. Tara O’Brien Administrative Lead Medical Lead Women’s College Hospital Women’s College Hospital [email protected] [email protected]

Ian Stanaitis Kyle Liang Project Manager Project Coordinator Women’s College Hospital Women’s College Hospital [email protected] [email protected] LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

Meet the Team – Clinical

Advanced Practice Virtual Care Nurses Toronto Paramedic Services Women’s College Hospital 2 Centre for Quality Improvement and Patient Safety – C-QuIPS Hospital Resource Partners Baycrest Ontario General Medicine Quality Humber River Hospital Improvement Network – GeMQIN Michael Garron Hospital 12 North York General Hospital LifeLabs Scarborough Health Network

Sinai Health System Sunnybrook Health Sciences Dynacare Trillium Health Partners Unity Health – Toronto StL Diagnostic imaging University Health Network West Park Healthcare Centre Women’s College Hospital Medigas LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

Current Situation

• There is an urgent need to enhance the availability of services to support high quality medical care in LTC homes

• Over 70% of COVID-19-related deaths in Ontario have been LTC residents

• There is an opportunity to support and enhance non-COVID-19 and COVID-19 care for

many LTC residents

• Providing LTC homes access to services is a rapid method of expanding the capacity to deliver urgent and acute medical care in the health care system Our goal is to partner with all Long-Term Care Homes in the Toronto region providing access to enhanced care services. Goal of LTC+ Services are designed to enhance existing processes and protocols in place, with the local attending physician as the most responsible provider.

LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

Roles & Responsibilities When to connect with…

Ontario Health Planning, oversight, risk monitoring Toronto • Monitor and communicate emerging and rising risks • Collection of risk self-assessment data • Integrated, equitable and proactive PPE allocation Hospital Resource LTC Outreach, SWAT team in high risk homes Partner (HRP) • IPAC (risk assessment, recommendations, implementation) • PPE (short-term and emergent PPE support) • Staffing (critical staffing needs and access to necessary supports and training) • Testing (mobile assessment teams) LTC+ Single point of access for medical supports and clinical services • Access to specialist consultation (GIM, Palliative, Geriatrics) • Direct nursing support • Enhanced behavioural supports (BSO and Baycrest) LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

• Some of your homes may have previously established communication channels with your HRP, including access to clinical services. To respect

the processes already in place, we will best tailor LTC+ services to meet

your needs.

• If you have not been contacted by your HRP, please email

[email protected] or contact our Advanced Practice Nurse and we

will make the connection for you. Press 1 to reach…

General Internal Medicine On-Call (24/7) • Access to urgent medical consultations and advice

Geriatrics

Palliative Care Advance Practice Virtual Care Nurse (9-5) Behavioural Supports • Rapid needs assessment, advice, and Attending MD linkage to services Wound Care in LTC can access… GeriMedRisk Press 2 to reach… Neurology

Enhanced Point of Care Services and Care Pathways • Mobile Diagnostic Imaging (STL Imaging) • Access to STAT labs through LifeLabs

LTC+ Program Overview LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

Case Example

● 85 year old man, resident at a LTC facility in Toronto, with a history of heart failure with reduced ejection fraction and stage III chronic kidney disease

● Recent discharge from acute care -- admitted for hypercalcemia secondary to severe primary hyperparathyroidism

● Primary care physician (PCP) called by RN at the LTC because resident was less responsive, but with stable vital signs

● The PCP suspected recurrent hypercalcemia but needed advice on how to manage – so called the GIM consultant on call

● After discussing the case by phone, the GIM consultant made several recommendations – including initiating hypodermoclysis, holding the diuretics, and checking a capillary blood glucose level; the GIM consultant also confirmed that since IV pamidronate already given on the recent admission, no further treatment other than fluids would be helpful Continued... LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

Case Example

● The PCP ordered STAT labs and confirmed that the calcium level was elevated, but that the renal function was stable

● The PCP spoke with the resident’s daughter and explained that he is receiving the same care that he would receive in acute care, and that an internal medicine specialist had provided advice and would continue to be involved – his daughter agreed she would not want him transferred

● Two days later, the SC fluids lowered the calcium level, the resident was more responsive, and started eating and drinking again, and taking all of his medications – he continued to do well 1 week later

● The GIM specialist checked in by e-mail 1-2 additional times Our Commitment

• Availability of the program (we are here to support you) Collaboration • Expansion of services where possible to better meet your needs Principles

• Avenue for you to provide feedback and advice on how to better meet your needs

Our Ask of You

• Engage and encourage your attending MDs/NPs to use the service

• Share ideas and feedback around services in Collaboration need Principles • Participate in LTC+ team engagement (check-ins, reminders of available services)

• Help us with data collection to improve the services we offer, i.e. follow-up to ask about process/case (no PHI)

LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

How to Get Started

1. We will send the Medical Director, Home Administrator, and Director of Care an email with the LTC+ one number to call to access the LTC+ Virtual Hub, along with additional resources and information about the program.

2. Visit https://ltcplus.ca for access to fact sheets, guidelines and other clinical resources. LTC+ Virtual Care Support for Long-Term Care Homes in Ontario

Our Partners